Study On The Correlation Between Blood Loss And Anemia,Hypoalbuminemia And Hypocalcemia After Joint Replacement

Objective: To investigate the total blood loss and the incidence of anemia,hypoalbuminemia and hypocalcemia after total hip and knee arthroplasty.And further explore the influence of blood transfusion on hypoalbuminemia and hypocalcemia;the correlation between age and postoperative hypoalbuminemia and hypocalcemia;the correlation between operation blood loss and operation time,albumin and serum calcium changes before and after operation,and establish multiple linear regression model,so as to guide early intervention methods for high-risk groups.Participants and methods: From January 2019 to October 2020,426 patients with primary total knee arthroplasty,primary unicompartmental knee arthroplasty,primary total hip arthroplasty and primary femoral head arthroplasty(190 cases of unilateral total knee arthroplasty,29 cases of bilateral total knee arthroplasty at the same time,18 cases of unilateral unicompartmental knee arthroplasty)were enrolled in this study Methods:five patients underwent simultaneous bilateral unicompartmental knee arthroplasty,95 patients underwent unilateral total hip arthroplasty,13 patients underwent simultaneous bilateral total hip arthroplasty,and 76 patients underwent femoral head arthroplasty The basic data of age,gender,height,weight,BMI,operation time,HCT,Hb,albumin and serum calcium before and 72 hours after operation were recorded.The mean value and standard deviation of the above indexes were calculated respectively,and the incidence rates of anemia,hypoalbuminemia and hypocalcemia before and after operation were calculated.Chi square test was used to compare the statistical differences.In order to exclude the influence of blood transfusion on the changes of serum calcium and albumin,the patients were divided into two groups according to whether they received component blood transfusion,including 168 cases in blood transfusion group and 258 cases in non blood transfusion group.After normal test,independent sample t test was used to compare the changes of albumin and serum calcium between the two groups.After the normal test of blood loss,operation time,albumin change and serum calcium change,the scatter diagram was drawn,and the change rule was observed directly.Then Pearson correlation analysis was used: 1.The correlation between serum calcium,albumin change and patients’ age before and after operation;2.The correlation between operation blood loss and operation time,albumin change and serum calcium change.Finally,the optimal linear regression equation model was established by multiple linear regression analysis(stepwise method)with operation time,albumin and serum calcium changes before and after operation as independent variables and operation blood loss as dependent variables.Results: 1.There were 58 cases(13.62%)of preoperative hypoalbuminemia and 300cases(70.4%)of postoperative hypoalbuminemia,the latter was significantly more than the former.The incidence of hypocalcemia before and after operation was significantly different by chi square test(P < 0.01).The postoperative albumin was(32.66 ± 3.90)g /L,the change of albumin was(7.72 ± 3.66)g / L,and the incidence of preoperative hypocalcemia was(3.33 ± 3.66)g / L There were 8 cases(8.9%)and 340 cases(79.8%)with hypocalcemia after operation.The incidence rate of hypocalcemia before and after operation was significantly higher than that of the former by chi square test(P < 0.01).Serum calcium was(2.13 ± 1.01)mmol / L after operation and(0.203 ± 0.102)mmol /L before and after operation.2.In order to exclude the influence of blood transfusion on the changes of blood calcium and albumin,the above patients were divided into two groups according to whether they received component blood transfusion.There was no significant difference in the basic data between the two groups(P > 0.05),and the K-S normality test of the above two data was in line with the normal distribution(P > 0.05).After independent sample t-test,the results of P1(albumin change)= 0.977 > 0.05,P2(blood calcium change)= 0.246 > 0.05,that is,there was no statistical difference between the two groups.3.Pearson correlation analysis showed that there was a significant positive correlation between the changes of serum calcium and albumin before and after operation and the age of patients(P1 < 0.01,P2 < 0.05),and the correlation was(0.152)and(0.098),respectively;there was a significant positive correlation between the amount of blood loss after operation and the length of operation,the changes of albumin after operation and the changes of serum calcium after operation(P < 0.01),and the order of correlation was serum calcium 496)> albumin(0.455)>operation time(0.313).4.The results of stepwise multiple linear regression analysis are as follows: R2(after adjustment)of the best fit model is 0.343,P < 0.01;DW = 1.843.The optimal linear regression equation was established with blood loss(y)as dependent variable,operation time(X1),albumin change(X2)and serum calcium change(X3)as independent variables: Y = 43.297 + 2.966X1 + 27.32X2 + 593.018X3.The standard regression coefficient from large to small was operation time(0.349)> albumin change(0.293)> serum calcium change(0.178).Conclusion: The incidence of hypocalcemia,hypoproteinemia and blood transfusion in patients undergoing hip and knee arthroplasty is 79.8%,70.4% and 39.4%,respectively.The incidence of anemia was 49.5%.Blood transfusion did not reduce the incidence of hypoalbuminemia and hypocalcemia.Pearson correlation analysis and multiple linear regression model showed that: 1.The changes of serum calcium and albumin before and after surgery were significantly positively correlated with the age of patients;2.Reducing blood loss and shortening operation time can reduce the changes of albumin and serum calcium before and after joint replacement.Therefore,it is suggested that: 1.According to the physical condition of the elderly patients,intervention measures can be implemented to maintain the stability of albumin and calcium ion during the perioperative period;2.For the elderly patients whose preoperative albumin test results are lower than 42.0 g / L,nutrition should be strengthened,corresponding dietary plan should be formulated or oral / intravenous albumin supplement should be made;for the elderly patients whose preoperative serum calcium test results are lower than 2.30 mmol /L,joint replacement should be carried out It is necessary for the patients to take calcium orally or intravenously;3.Early intervention should be carried out for the operation with large blood loss;4.Try to control the operation time and blood loss,so as to stabilize the perioperative Hb,albumin and blood calcium levels in the normal range.